Lateral column lengthening

If you have been advised to undergo an operation called “lateral column lengthening” full details are contained on this page. We divide the foot conveniently into two columns, one the outside border called the lateral column and the other the inside border called the medial column.

The troublesome foot is shaped such that the inside of the foot is relatively longer than the outside and we therefore lengthen the outside border.

  • The operation involves a general anaesthetic as well as local anaesthetic to numb the foot. In cases of bilateral surgery a spinal or epidural injection will be added so that both legs are numbed. Both feet operated on together is only suitable for younger children.
  • A wound is made on the outside of the foot and the heel bone cut.  The bone is lengthened and a block of bone graft inserted.

    Lateral column lengthening healed1

    Graft seen in lateral column

  • The bone graft is usually taken from the iliac crest of the patient. Sometimes a cadaveric donor is used (NHS Bone bank (tricortical wedge)) or artificial grafts can be used and the graft fills the gap made when lengthening the bone.  The body lays down new bone on the graft over several weeks and matures over several months. In those cases where graft is taken from the pelvis (iliac crest) this results in an additional scar and can be painful for several weeks and the donor graft is preferred and recommended. In adults, a metal implant can be used in place of the bone graft.
  • The bone graft is held in place using either two wires or a plate and screws. It is often necessary for a second incision to be made over the inner border of the foot to tighten the soft tissues and ligaments and may also involve advancing tendons. Mr Uglow would usually have explained this to you prior to surgery.
  • If wires are used to hold the bone they will protrude through the skin and be covered by bandages.  The limb will be placed in a below knee plaster to the base of the toes.
  • In the first six weeks you will be walking with crutches, but not taking weight through the leg. Light pressure can be taken by allowing the leg to rest on the floor, but not to try to increase the weight through the leg at this stage.

    Typical foot posture and excellent scarring following surgery

    Typical foot posture and excellent scarring following surgery

  • The wires will be removed 6 weeks after the operation and the cast changed.
  • You will be able to take weight through the second cast initially with crutches, and by the end of the six weeks, walking without the need for crutches.
  • At three months the cast is removed and an X-ray taken.  You will require physiotherapy to help with the rehabilitation process.
  • The end point of recovery following this operation is usually between six and nine months.  This is a prolonged time period, but the function improves quite rapidly once you come out of plaster at three months such that by approximately five to six months activities of daily living are being performed without discomfort or any obvious limitation.  Occasional discomfort and aching will occur from time to time.

    Excellent function on toe standing with good inversion seen (heels turning in)

    Excellent function on toe standing with good inversion seen (heels turning in)

  • In the long-term most patients do very well following this procedure. Occasionally some symptoms can persist and the foot may remain uncomfortable for various reasons.  The arch on the inner side of the foot should be deeper than before the operation and shoewear fitting is often much easier.  Full function, including sporting activity, is to be expected once the foot has settled following surgery.

As with all procedures, if any questions arise do not hesitate to contact Mr Uglow.